Long-stay patients in pediatric intensive care unit: Diagnostic-specific definition and predictors
Angelo Polito1, Christophe Combescure2, Yann Levy-Jamet1
1Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
Insights
A new definition for long-stay patients (LSPs) in pediatric intensive care units (PICUs) was established, identifying the top 10% of longest stays. Readmission and higher initial acuity predict longer PICU stays, suggesting personalized LSP definitions are needed.
Area of Science:
- Pediatric Intensive Care
- Healthcare Management
- Clinical Informatics
Background:
- Defining long-stay patients (LSPs) in pediatric intensive care units (PICUs) is crucial for resource allocation and care optimization.
- Existing definitions may not adequately account for variations in patient populations and diagnoses.
- A standardized yet adaptable definition is needed to improve patient outcomes and operational efficiency.
Purpose of the Study:
- To establish a novel definition for LSPs in PICU based on length-of-stay (LOS).
- To determine if LSP thresholds differ significantly across pediatric age and diagnostic groups.
- To identify patient characteristics at admission associated with LSP status.
Main Methods:
- A multicenter retrospective cohort study was conducted across all Swiss PICUs.
- Long-stay patients (LSPs) were defined as the 10% with the longest PICU length-of-stay (LOS) within specific age and diagnostic groups.
- Multivariable regression analysis examined associations between admission variables and LSP status.
Main Results:
- The study included 22,284 pediatric patients.
- Significantly different LOS thresholds for defining LSPs were observed across diagnostic and age subgroups.
- Patient readmission to PICU and higher PIM2 and NEMS scores at admission were associated with an increased likelihood of being an LSP.
Conclusions:
- The definition of LSPs in PICU varies significantly based on specific diagnoses and age categories.
- Readmission and higher initial acuity are key predictors of longer PICU stays across most diagnostic groups.
- Personalized LSP definitions, considering patient-specific factors, are recommended for optimizing care and reducing costs.
Aims:
To stipulate a new definition for long-stay patients (LSPs) in pediatric intensive care unit (PICU). We defined LSPs as the 10% of patients with the longest PICU length-of-stay (LOS) for each age and diagnostic group. To assess whether the thresholds (days of PICU stay) for the definition of LSPs in PICU significantly differ among diagnostic and age categories. To determine whether independent associations exist between patients' characteristics at admission and LSPs diagnosis in pre-specified diagnostic and age groups.
Methods:
This was a multicenter retrospective cohort study including all PICUs in Switzerland. Multivariable regression analysis was used to seek for association between patients' variables at admission and LSPs.
Results:
We included 22,284 patients with a median (IQR) age of 12 (1-84) months. Significantly different thresholds across diagnostic and age subgroups are identified. Readmission to PICU, higher PIM2 and NEMS (a score used to quantify nursing workload at intensive care unit level) at admission were associated with higher likelihood of becoming LSPs.
Conclusions:
Our results showed a significantly different definitions of LSPs for specific diagnoses and age categories. Readmission to PICU and higher acuity at admission are associated with longer PICU length-of-stay in the majority of diagnostic groups. A more personalized definition of LSPs in children based on actual patients' characteristics should probably be used in an effort to optimize care and reduce costs.
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